Role of a Midwife in Mothers Opting for a VBAC

Ever heard about a midwife? Did you get to choose your midwife during your pregnancy? You might think that a midwife is ‘just a nurse who assists the doctor when you are having a baby’, but you would be wrong!

The Mindful Midwife…

She is a nursing professional who has undergone advanced further training, usually for a period of 2 years. She is able to care for the mothers during pregnancy, labour and the postpartum period. She supports the mother-to-be during her birthing process and provides invaluable care that a mother and baby needs.

At Fernandez Hospital, we provide the right information and necessary support to encourage natural birthing. We have a team of skilled professional midwives who will support you and be your advocate during your pregnancy. Every mother needs a companion during her pregnancy. This is where your midwife can help.

There is a high percentage of C-section in India. If you’re expecting a baby after your previous cesarean and wish for a natural childbirth process, don’t worry! It is possible to opt for Vaginal Birth After Caesarean (VBAC) this time. Your midwife will be able to support you, discuss your previous birth and help you feel confident to approach a VBAC this time. 

What is VBAC?

VBAC refers to Vaginal Birth After Caesarean which is an option given to the women. It’s the term used for a woman who had undergone a caesarean previously and in this pregnancy is opting for a normal vaginal birth. Successful vaginal birth is possible for 60-80% of the women planning for a VBAC. However, it is important to choose the right hospital and health professionals who will support you with this choice.

Fernandez Hospital Foundation has some of the best success rates in Hyderabad and we also have professional midwives and obstetricians who will encourage and support you in your choice.

If you had a history of one lower segment caesarean with no other risk factorsyour midwife or obstetrician will discuss the following options with you –

Fetal monitoring

All women should be offered continuous fetal monitoring with a cardiotocography (CTG) as recommended by the National Institute for Health and Care Excellence (NICE).

Risks

If you request for intermittent monitoring, the risks and benefits will be explained to you. You and your partner should understand that intermittent monitoring may result in a delay in recognizing fetal compromise and/or uterine rupture.

Benefits of VBAC

There are many benefits to you and your baby for VBAC. They include you are less likely to develop an infection, bleeding and will recover sooner from your childbirth. Your baby is less likely to experience breathing problems at the time of birth and is more likely to experience skin to skin contact and breastfeed sooner.

Induction of labour including membrane sweep

If you have a uterine scar, the best chance that your labour will be straightforward is to go into spontaneous labour. Inducing labour can carry a higher risk of uterine rupture so you must discuss it with your obstetrician first.

If induction of labour is recommended by your obstetrician due to your specific circumstances then, you may be advised to have a vaginal examination and a cervical sweep at 40 weeks gestation. This can increase your chances of spontaneous birth.

Complications of a VBAC

In some cases, when a VBAC is not successful an emergency caesarean section is required. This happens in around one in every four women. There is a higher risk of complications (such as bleeding and infection) with an emergency caesarean section compared with a planned caesarean section.

In one out of 200 women (0.5%), the scar of the previous caesarean section opens up during labour (rupture of the womb). This rupture also happens in two out of 10,000 (0.02%) women planning to have Elective Repeat Caesarean Section (ERCS).

If a rupture occurs, there is an increased chance of bleeding and thus requires a more complicated surgery. There is also an increased risk of lack of oxygen to the placenta, which can cause temporary or permanent damage to your baby. However, this is a very rare event.

This is why we recommend care by an experienced team in a hospital with appropriate facilities to support you. Your midwife along with your obstetrician will support you and inform you about the preparation you will need for a successful VBAC.

A Birthing story with our Midwives…

At Fernandez Hospital Foundation, we work collaboratively as a team (midwives and obstetricians) to support and advice you about all your options and choices in birth. Your midwife will support you and your partner to be involved in your care and ensure you have a positive and safe experience. Right from writing your birth plan to guiding you during breastfeeding, be assured that your midwife will be the companion you can trust implicitly.

To encourage you to experience how a midwife can play a vital role during your childbirth, we’d like to share a story of Umama Nayeem who opted for VBAC at Fernandez Hospital.

Umama Nayeem was a young lady who decided to opt for VBAC in Fernandez Hospital. During her first childbirth in Fernandez Hospital, she had to undergo an emergency caesarean as she wasn’t prepared for it.

Umama started preparing herself for second childbirth and attended birthing classes. She even hired a doula (Ms. Zahra Bint) and wished to be in the best hospital in town for which she chose Fernandez Hospital again. During her pregnancy and labour, she was supported by her midwives Ms. Katherine Stringer and Ms. Asha Sobin. Umama’s consulting doctor was Dr. Sreedevi.

At Fernandez Hospital, her routine checkups started and she introduced her birth plan to her doctor, doula and midwives. The entire team supported her with positive words that made her strong at that point of time. As there were no natural signs of pain, she was called for a membrane sweep at about 39 +5weeks. When Umama’s contractions started occurring every 5 minutes Zahra helped her deal with the contractions by using a hot water bag and an acupressure massager. She even used clary sage on her forehead to calm her down. After reaching the hospital, her midwife informed her that the cervix was not yet dilated so they returned home.

For the labour to progress, Umama started putting extra efforts by walking, climbing stairs, swaying hips, squatting and bouncing on the ball. This helped increase her contractions at around 11 pm and she was taken back to the hospital. She was informed that she is 1 cm dilated and had to be admitted as her contractions were very intense. In the hospital, Umama was monitored intermittently. As her contractions were increasing Umama started vomiting and couldn’t consume anything due to which she was put on IV. The next morning, she was checked by her midwives and was 4 cms dilated.

Her water broke at 9 am and she was soon 10 cms dilated. Both her midwives guided her with different positions and pushing at the right time that would help the baby descend easily.

Umama could feel her baby coming out and gained energy after feeling her baby. She was determined to have her baby out while everyone encouraged her saying: “yes, yes you can do it, the baby is almost out”. It was just one last push when her baby entered this world at 12:29 pm. It was a beautiful moment as Umama held her baby in her arms with her husband by her side.

It was a complete natural birth with intact perineum and no epidurals required. Umama and her husband were keen on a delayed cord clamping and her husband happily cut the cord. Her successful VBAC baby weighed about 3.46 kgs. She was allowed to be in an upright position throughout her labour and was guided by her midwives thoroughly during her labour.

When asked about her birthing experience, Umama said –

“We made it till here. I believed in the power of prayers, I thanked God and everyone from my birth team. Without my birth team, this wouldn’t have been possible. I intend to bring awareness amongst all the to-be-mums that nothing is impossible when you’ve got the right support.”


Leave a Reply

Your email address will not be published. Required fields are marked *